The most desirable; most effective; best place to be.

I, Janie Bowthorpe, a hypo/Hashi’s patient, have been collecting over 2 decades of consistent patient-reported experiences & observations worldwide. And from that, we have learned that if our free T3 isn’t around “optimal”, the feel-goods we achieved eventually backfire. (mid-range isn’t optimal). The individuality is when symptoms return. Many also see their adrenals get stressed from not being optimal. READ EVERY SINGLE WORD ON THIS PAGE ALL THE WAY TO THE BOTTOM. DON’T SKIM!! Be prepared to teach your doc. ~Janie

NOTE: This entire page is copyrighted by Stop the Thyroid Madness.

So what is meant by being optimal? It’s not referring to how you feel!

The term optimal specifically refers to where our free T3 (the active thyroid hormone) should fall in a range to prevent an eventual backfire/return of our hypothyroid symptoms. It’s the free T3 that changes our lives, thus an emphasis here on it. And we have to have the right levels of cortisol and aldosterone to achieve that optimal result. (The right amount of iron is also important to stop rising RT3, the inactive thyroid hormone, which comes from T4).

  • WHEN ON A TREATMENT THAT PROVIDES BOTH T4 and T3 (a “working” NDT or synthetic T4 with synthetic T3): Gaining on over two decades of our observations and experiences as revealed by STTM, optimal puts the Free T3 (FT3) in the top part of the range (not midrange, not just above midrange), and a Free T4 (FT4) around midrange. Both, even if the FT3 is key.
  • WHEN ON A TREATMENT WITH T3-ONLY or MOSTLY T3 with a little T4: Again by our observations, optimal seems to be a Free T4 will naturally be low on T3-only, and patients have never reported a problem with that, other than you won’t be converting to T3 behind the scenes.

Why patients discovered that just going by “how I feel” can be a problem!

We, as hypothyroid patients, learned the hard way over the years that what seems to be a majority of us, we will start “feeling good” on doses that are NOT yet close enough to optimal, like a midrange free T3. Thus, many think they have arrived and stay with a non-optimal dose. Mistake!

Or another way to look at it: even though a certain amount of our thyroid meds may make us “feel good” or “feel better”, we’ve also seen that there comes a return of hypo symptoms if we didn’t achieve an “optimal” free T3. The individuality is when the return happens, whether in a few weeks, months, or a year or so. Plus, we’ve seen that the risk goes up that our adrenals will get stressed when we only go by “how we feel” and not by that free T3.

As we raise a thyroid treatment, we are also suppressing our own natural production and release of T3 (the communication from the hypothalamus, to the pituitary, to our thyroid), even if what our thyroid made was too low. So if we don’t achieve that optimal free T3, we go backwards, and some find themselves with stressed adrenals.

So we learned we have to find the right “replacement dose” to counter the above “suppression”. That seems to be a dose that gets the free T3 in the upper area of the range. Not a specific number–just the upper area. You can work with your doctor on what we’ve observed.(NOTE: it is rare for optimal to occur on nothing but T4.)

Don’t go backwards.

So tell me again: why may it backfire if we aren’t optimal with our FT3 (and FT4 if it’s in our treatment, too)?

  1. When we are on these thyroid meds (and if we still have a thyroid), they are going to suppress whatever remaining release of thyroid hormones we still have, even if that release is low. So to the degree we suppress, we need to replace in an amount that meets our weekly, monthly, and yearly needs. If we don’t replace enough, it eventually backfires.
  2. Whether with a thyroid or without one, all your organs need the right amount of T3 to function well, we have experienced as patients. Without the right amount, problems can rise up like depression, brain fog, concentration issues, cortisol issues, joint pain, liver stress as revealed by liver labs, heart issues, dry skin, hair loss..on and on and on.
  3. Certain life circumstances will need the right amount of free T3 to help us function better during stress or demands. So if we aren’t optimal, life can demand more than you may be giving yourself.

But I’ve had problems when I tried to raise and get my FT3 optimal..

If upon raising a treatment with T3 in it, you notice feeling hyper-like, or have either heart palpitations, higher heartrate, anxiety, shakiness, etc, that is pointing to having a CORTISOL PROBLEM–it’s not the fault of the T3.

i.e. having either low cortisol, high cortisol, or low aldosterone leads to the former symptoms when raising T3 or a medication with T3 in it (like a working desiccated thyroid, or T4/T3, or T3 alone). Why? We need the right amount of cortisol to distribute T3 to the cells. Aldosterone seems to also play a role. Without the right amount of both, T3 simply starts building high in the blood and not making it to the cells. This is called pooling. Thus, we first need to order and do a saliva cortisol test, we learned over and over. It is never about blood testing. Then you need the STTM I book to understand how to treat these.

Having a rising RT3 (reverse T3)

If we are raising a working NDT like Armour, or T4/T3, and we see the RT3 (reverse T3) lab go up, we have either inadequate iron levels, inflammation or high cortisol. Any will need discovery and treatment. LOOK —> Rising RT3 will eventually start lowering our free T3.

Having a TSH-obsessed doctor who makes you lower your meds

As much as we like having a relationship with the doctor, this is one area we strongly have noted they are wrong and backwards about. It’s natural for the TSH to go very low, and it does NOT cause bone or heart problems. They are confusing it with Graves’ disease which causes causes the latter with a low TSH. There is a complete chapter on the ridiculous TSH in the STTM 1 book.

Here are different thyroid treatments that work for Hashimoto’s or hypothyroidism of any cause:

  • A working natural desiccated thyroid (Armour has consistently worked if we get those frees optimal)
  • Synthetic T4 with Synthetic T3
  • T3-only, multi-dosed.
  • A working compounded NDT
  • A small amount of a working desiccated thyroid with added T3 (to help lower high RT3 until we fully treat the causes)
  • Over-the-counter bovine NDT’s (But beware…there are many instances over the years where a particular batch brought back hypo symptoms or odd labs, or rising RT3. That’s why patients keep a supply of T3 handy)
  • Other non-American made NDT brands.

Do I test my free’s within a few days after a raise of my thyroid meds?

If we have both T4 and T3 in our treatment, we’ve noted that it takes a few weeks to see the conversion results of T4 to T3. So testing should wait a few weeks. But if on nothing but T3, we can test the free T3 in about a week. More in the STTM 1 book.

Do I test my free’s after taking a dose of thyroid meds?

We’ve sure learned the hard way that it’s a big NO!! That is because there is a slight rise of T4 after taking meds, and a definite high rise of T3 after taking T3-containing meds. We don’t want to test those temporary rises. We want to know what we are hanging onto. So we take our meds as usual one day, then test the next morning BEFORE taking our thyroid meds for the day. (If on a T3-containing treatment, best to take it twice, or three times a day, before the next day morning test). More in the STTM 1 book.

I have an optimal Free T3 (top of range) or higher, but Free T4 is really low?

  1. If this is occurring when on both T4 and T3, that can be about pooling and reveals a cortisol problem. Read this.
  2. This can also happen if we are on a larger amount of T3 meds and a smaller amount of T4 meds. No biggie.
  3. If this is occurring and you are only on T3-only, that is very normal if you feel great. If you don’t feel great, it’s also about pooling. More in the STTM 1 book.

Can I get optimal on just T4-only like Levo or Synthroid?

Hardly ever, we have experienced or observed as patients for decades, except for that one, lucky, stray patient. And even when someone gets close, it’s not uncommon to still see problems, sooner or later. Sadly, there are too many life situations that can block the conversion of T4 to T3. There is a complete chapter in the STTM 1 book you need to read on the problem with T4.

Can I get optimal on a low dose of T3/low dose of a working NDT, with a lot of added T4.

Hardly ever, we have experienced. It’s puts us right back to depending mostly on conversion of T4 to T3.

I’m seeing my TSH go below range…

Even on non-optimal doses of a treatment with both T4 and T3, or T3-only, we have seen that it’s typical and expected to see a TSH lab result go below the range. IT’S NOT HYPERTHYROIDISM. Our TSH is simply sensitive to T3 in our treatment. And it will continue being low as we make our way up to an optimal dose.

Sadly, many report they’ve had to stand firm against doctors who wrongly freak out about that normal low TSH with T3 in your treatment. Our low TSH is not the same as the low TSH seen with Graves’ disease, the hyperthyroid side of the coin that doctors confuse it with. Our low TSH when optimal with the frees does NOT cause bone loss or heart disease–it’s uncontrolled Graves’ disease that can do that, or still being underdosed, or having an iron or cortisol problem keeping us underdosed.

To the contrary, when we are nearing optimal with our free T3, patients have reported improved bone health via scands, and improved heart health via symptoms and tests!!

What about when I get older?? Will “optimal” levels be true when I’m much older? Will it work if I have other health issues?

We’ve seen those in their 60s and 70’s report doing well with the optimal goal. But we don’t have enough feedback or experiences to know if this will be too high for everyone with an aging body with less activity. This is where if you fit this age range, it can help to find a good doctor to work with, just in case.

As far as other health issues, this is also where it’s important to work with your doctor.

<—THIS is your reference book, whether soft cover or hardbound, CHOCK FULL of important patient-to-patient information and all the ways patients got well. Includes updates and other good information based on years of patient wisdom. Throughout, the updated revision STTM book mentions “optimal” as well as more information that is crucial to getting fully well again. https://laughinggrapepublishing.com

Have autoimmune Hashimoto’s disease? —-> This is also your book with important patient-to-patient information on how to put those antibodies into remission. As a companion book to the above, Hashimoto’s: Taming the Beast has been put together in an easier to read layout–no excessively long chapters, no chit-chat or long stories. READ MORE HERE: https://laughinggrapepublishing.com

Don’t discount these life-changing books just because there is a website. There is important info in these books that won’t be covered the same way on the site. Plus, patients report getting even more from books where they can highlight, underline or bookmark the pages. One place to order is right here.

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.